Schumacher B, Stegmann T, Pecher P
Department of Cardiac Surgery, University of Ulm, Germany.
J Cardiovasc Surg (Torino). 1998 Dec;39(6):783-9.
This paper is a report of our clinical experience with the human growth factor FGF as applied to the ischemic human myocardium.
After the completion of extensive preliminary animal experiments, the growth factor FGF, obtained from genetically manipulated E. coli bacteria and highly purified, was introduced into aortocoronary bypass surgery as an additional therapeutic agent. A double blind study was carried out on 40 patients with CHD, separated into "growth factor" and control groups, each containing 20 members. All the patients were treated for threefold vascular disease, in each case with an IMA bypass for the LAD and single venous bypasses for the RCX and/or RCA. In order to bridge over additional peripheral stenoses in the LAD or one of its branches, human growth factor FGF was injected into the myocardium of those in the growth factor group. Twelve weeks later, the IMA bypasses were selectively demonstrated by intraarterial DSA. These angiographs were then quantitatively evaluated.
In all patients of the growth factor group, the formation of new vessels could be demonstrated in the region where FGF had been administered, in a manner strictly reminiscent of our experimental results. A capillary net sprouting from the coronary artery and making further connection with this vessel could be demonstrated, and the computer-supported evaluation of the angiographs showed a significant increase in the blood supply of the region of the myocardium injected.
It is therefore our opinion that employment of the human growth factor FGF represents a useful extension to bypass surgery, particularly for patients with an additional peripheral stenosis that cannot be operatively revascularized.
本文报告了我们将人类生长因子FGF应用于缺血性人类心肌的临床经验。
在完成广泛的初步动物实验后，将从基因工程改造的大肠杆菌中获得并高度纯化的生长因子FGF作为一种额外的治疗剂引入主动脉冠状动脉搭桥手术。对40例冠心病患者进行了双盲研究，分为“生长因子”组和对照组，每组20例。所有患者均接受三支血管疾病治疗，每种情况均采用IMA绕过LAD，采用单静脉绕过RCX和/或RCA。为了跨越LAD或其分支中的额外外周狭窄，将人类生长因子FGF注入生长因子组患者的心肌中。12周后，通过动脉内DSA选择性显示IMA搭桥。然后对这些血管造影进行定量评估。
在生长因子组的所有患者中，在给予FGF的区域可证实有新血管形成，其方式与我们的实验结果极为相似。可证实有一个从冠状动脉发出并与该血管进一步连接的毛细血管网，并且血管造影的计算机辅助评估显示注入心肌区域的血液供应有显著增加。
因此，我们认为使用人类生长因子FGF是搭桥手术的有益扩展，特别是对于伴有无法通过手术进行血管重建的额外外周狭窄的患者。
